title: Bloodstream infection after elective liver transplantation is associated with increased mortality in patients with cirrhosis.
abstract: OBJECTIVE
  This study aims to investigate what factors predict the development of postoperative bloodstream infection (BSI) in patients transplanted electively for chronic liver disease and compare outcomes in infected transplant recipients (BCLD) with noninfected patients (CLD).
  
  
  METHODS
  A retrospective cohort study of 218 patients who had elective liver transplantation (LT) between January 2003 and July 2005 and admitted to a specialist intensive care unit (ICU) was done.
  
  
  RESULTS
  Fifteen patients had BSI post-LT (BCLD, 29 isolates) while in the ICU, and 203 patients did not (CLD). Thirty-eight percent of isolates were gram negatives; 55%, gram positives; and 7%, fungemia. Median time to first BSI post-LT was 11 days (range, 3-16 days). On admission post-LT to the ICU, patients with BCLD had higher Acute Physiology and Chronic Health Evaluation II scores (23 vs 10, P < .001). While in the ICU, patients with BCLD had greater requirements for renal replacement therapy (73% vs 8%) and days on mechanical ventilation (17 vs 2 days) and longer median ICU stay (21 vs 3 days, P < .001 for all). One-year survival was worse in the BCLD group (40% vs 94%, P < .001). On multivariate analysis, Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.36) post-LT was independently associated with subsequent BSI. Bloodstream infection (hazards ratio, 8.7) was independently associated with mortality.
  
  
  CONCLUSIONS
  Bloodstream infection post-LT was associated with increased severity of illness on admission, greater requirements for organ support, and increased mortality.
authors.affiliation: Divisions of Gastroenterology (Liver Unit) and Critical Care Medicine, University of Alberta, Edmonton, Canada; Institute of Liver Studies, King's College Hospital, Denmark Hill, London, United Kingdom. Electronic address: cjk2@ualberta.ca.
authors.forename: Constantine J
authors.initials: CJ
authors.lastname: Karvellas
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, United Kingdom. Electronic address: markmcphail@doctors.org.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: McPhail
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, United Kingdom. Electronic address: fredpink@doctors.org.uk.
authors.forename: Fred
authors.initials: F
authors.lastname: Pink
authors.affiliation: Department of Surgery, University of Alberta, Edmonton, Canada. Electronic address: sonal.asthana@ualberta.ca.
authors.forename: Sonal
authors.initials: S
authors.lastname: Asthana
authors.affiliation: The Liver Unit, Birmingham University Hospital, Birmingham, United Kingdom. Electronic address: paolo.muiesan@uhb.nhs.uk.
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, United Kingdom. Electronic address: nigel.heaton@nhs.net.
authors.forename: Nigel
authors.initials: N
authors.lastname: Heaton
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, United Kingdom. Electronic address: georg.auzinger@kch.nhs.uk.
authors.forename: Georg
authors.initials: G
authors.lastname: Auzinger
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, United Kingdom. Electronic address: william.bernal@kcl.ac.uk.
authors.forename: William
authors.initials: W
authors.lastname: Bernal
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, United Kingdom. Electronic address: ian.eltringham@kch.nhs.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Eltringham
authors.affiliation: Institute of Liver Studies, King's College Hospital, Denmark Hill, London, United Kingdom. Electronic address: julia.wendon@kcl.ac.uk.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Wendon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology* / Q000401:mortality; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult